• Alecia Staines

Why has normal birth become so elusive? (it's nothing to do with the birthing woman)

My personal background:

Back in 2011, I began my maternity consumer representative journey. With a very small 10-day-old baby rested upon my shoulder, and a dodgey skype connection, I was catapulted into the political landscape of birth. It was my first “meeting” for consumer representation, and whilst most of it went over my head, I was offered a role collating consumer feedback and contributing to the first Normal Birth Guidelines for Queensland. I didn’t really know what this entailed, but I soon began googling other guidelines from around the world, to see if I could get a grasp of what was working well in other parts of the world.

Fast forward 5 years, and I’m still a consumer representative on the Queensland Health Clinical Guidelines, and the Normal Birth Guidelines are up for review this year. I’ll soon be with a newborn again (number 4 this time!), but am far more savvy and wise and have a good breadth of understanding of the maternity care system and the politics that interferes with a woman’s basic human right every day.

The Normal Birth Guidelines under a lense:

A recent study published by Toohill, Sidebotham, Gamble, Fenwick, Creedy (2016) titled “Factors influencing midwives’ use of an evidence based Normal Birth Guideline” showed some vast contrast between what midwives understand of normal birth and what is actually happening in our maternity sector.

So why is a normal birth so elusive to so many of us?!?!

I am somewhat shocked, but more so disappointed that the work that went into these guidelines is somewhat wasted by the policies and politics within the institutions that are meant to support birthing women.

Although 90% of midwives were aware of the Normal Birth Guidelines, only 71% reported that it routinely guided practice. What a disappointing outcome for women in their care!

Most agreed that women should be supported to achieve a normal birth, but only half of organizational process facilitated the use of the guidelines, the reported data shows.

These very guidelines were designed to promote consistency across health professionals, in an evidence-based fashion, to support normal birth. In the last 5 years though, we’ve seen a continued in crease in cesarean rates by about 1% per year, and as of 2014, our spontaneous vaginal birth rate is still only 54%.

Women aren't to blame at all, although often the institution and the "risk policies" aka "hoops" women have to jump through interfere and impact her chances of having a normal birth.


There are a couple factors identified in this study, along with my personal beliefs as to why these guidelines have really “failed” in their implementation:

  • benchmarking/reporting against similar services around normal births, along with reviews in order to improve normal birth rates and use of guidelines within facilities. This needs to be as KPIs for the health service.

  • Data reporting- consumers need transparency, but also there needs to be an undoing of the culture of secrecy of reporting, as there needs to be organizational structures to support normal birth in our birth suites.

  • education of midwives, and all levels of staff around the evidence base of guidelines and an acknowledgement of the “risk aversive” culture that leads to over-medicalisation.

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